Electroconvulsive treatment, sometimes called "shock therapy," is often an effective alternative to medication for these very ill patients. Consideration should also be given to whether the patient has bipolar disorder and might need mood stabilizer medication.
Psychotherapy, or talk therapy, tends to have little impact in helping to treat madness, or psychosis, as these patients typically do not have the reasoning power with which to unlock the doors to the prison of false belief in which they are locked up. Directly altering the chemistry of the brain provides the key to releasing them from the throes of illness.
When treatment takes hold, patients' moods improve; the depression lifts. And the delusional beliefs disappear.
How and why these symptoms of madness arise remains a mystery. It has long been known that genetic predisposition plays a role. The Swiss physician Paracelsus wrote in his 1520 treatise, "Diseases Which Lead to a Loss of Reason," that "the truly insane are those who have been suffering from it since birth and have brought it from the womb as a family heritage"
Yet we cannot explain why the transient psychotic symptoms that emerge in some depressions occur and then disappear. Our best clue at the moment centers on the neurotransmitter dopamine, which transmits signals from one brain cell to the next. We know that antipsychotic medications work primarily by blocking this transmission, suggesting that there is an excess of dopamine signaling in the midst of psychotic illness.
We anticipate that ongoing research into the genetics and neurobiology of depression will allow us to follow this clue and flesh out the rest of what is likely to be a complex story of disordered chemistry in the brain.
Dr. James Potash is an Associate Professor of Psychiatry and Co-Director of the Mood Disorders Program (http://www.hopkinsmedicine.org/moods) at the Johns Hopkins School of Medicine in Baltimore, Maryland. If you have questions or comments, please email at firstname.lastname@example.org. To participate in our studies, call 1-877-MOODS-JH.